No Place Like Home

As a boy, Rick Heady got used to the company of crusty old veterans. His parents ran a “family care” facility for some two dozen disabled ex-soldiers out of his childhood home, a cavernous three-story Victorian. Heady’s grandparents did the same; in the 1930s, they even housed one of the last surviving members of the Union Army.

Heady always wanted to continue the family tradition, but in the hyperspecialized world of twenty-first-century America, he had neither the training nor the kind of facility it required. So he wound up working as an AutoZone manager and a sometime motorcycle mechanic, living in a modest single-family home outside Tampa, Florida.

Then one day a few years ago, Heady’s dad told him about a new program run by the Department of Veterans Affairs. Known as the medical foster home program, it not only offers a solution for one of the deepest challenges facing American society—the explosive growth in the numbers of frail elderly—it also offers homeowners like Heady a way to earn a modest and meaningful living.

Under the program, the VA pairs veterans who would otherwise live in nursing homes with ordinary citizens who are willing to take them into their homes and help them with tasks like bathing, administering medication, cooking meals, changing diapers, and the like. Veterans pay their caregivers an average of just under $2,500 a month, using their Social Security checks, VA pensions, and whatever other benefits and savings they have. And most crucially, the VA supplies primary medical care for the veterans right in their foster homes via what is essentially a suped-up system of old-fashioned house calls from nurses, doctors, and therapists—who thereby also provide regular oversight of the homes. This allows for dramatically lower cost, and better-coordinated care. (Treating a vet in a medical foster home costs the VA about $52 a day, compared with an average of $580 a day for those in nursing homes.) It also helps prevent the neglect and elder abuse that can be common in other small residential settings.

Today, Heady cares for two disabled vets in his home. (The VA allows a maximum of three.) The guys live right down the hall from Heady’s teenage stepdaughter, whose room is decked out in Twilight paraphernalia and painted deep purple. The family had to renovate one of its bathrooms to accommodate a wheelchair-friendly shower, but otherwise the place has the look and feel of a normal, buzzing household. “You have to have the right mindset,” he says. “But you don’t have to put in a hundred-thousand-dollar sprinkler system.”

A blond-haired, thickset man with a handlebar mustache, Heady brims with pride in his work—and in the knowledge that he is keeping two men out of the escalating clockwork of institutional long-term care. “These are my guys forever,” Heady says. “When they require a higher level of care, I’m going to be able to provide it without them having to start all over somewhere else.”

Today, only about 500 veterans live in medical foster homes. But a little-known component of the 2010 Affordable Care Act, which as of this writing may or may not be struck down by the U.S. Supreme Court, could open up this model to a far larger population. The bill sets up a demonstration project called Independence at Home that will extend something much like the VA’s home-based primary care program to some 10,000 homebound Americans on Medicare. The study got started last month. If it succeeds, a vastly expanded system of foster care for the disabled elderly could follow.

Such an approach could provide high-quality, cost-effective care for millions of Americans who would otherwise languish in nursing homes. It also could provide economic sustenance for able-bodied older homeowners who lack adequate retirement savings but have rooms to spare and, quite often, personal experience taking care of sick loved ones.

These are the sort of folks who have already been drawn to the program. One caregiver I met in Florida was a widow who had cared for her husband in his last years. Another was a former teacher who had recently taken care of a brother with terminal lung cancer; she signed up to take a veteran into her home shortly after he died. It just seemed like a natural move, she said. And she assured me that she would just as soon take in a civilian.